Journal
JOURNAL OF CLINICAL MEDICINE
Volume 11, Issue 9, Pages -Publisher
MDPI
DOI: 10.3390/jcm11092367
Keywords
pancreatic ductal adenocarcinoma; perineural invasion; risk stratification
Categories
Funding
- Charite-Universitatsmedizin Berlin
- German Research Foundation (DFG)
- Berliner Krebsgesellschaft (BKG) [FEFF202108]
- Charite - Universitatsmedizin Berlin
- Berlin Institute of Health
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This study confirms the improvement in long-term survival of PDAC-resected cancer patients with Pn0, and highlights the significant impact of perineural invasion on the long-term survival of formally curative patients. These findings provide new insights into risk stratification and multimodal treatment strategies for pancreatic cancer patients.
(1) Background: Perineural invasion (PNI) is a common characteristic of pancreatic ductal adenocarcinoma (PDAC) and is present in most resection margins. We hypothesized that curative pancreatic tumor resection with long-term survival could only be achieved in PNI-negative patients. (2) Material and Methods: A retrospective investigation of PDAC patients who underwent curative-intended surgery during the period 2008 to 2019 was performed at our institution. (3) Results: We identified 571 of 660 (86.5%) resected patients with well-annotated reports and complete datasets. Of those, 531 patients (93%) exhibited tumors with perineural invasion (Pn1), while 40 (7%) were negative for PNI (Pn0). The majority of patients in the Pn1 group presented advanced tumor stage and positive lymph node infiltration. Patients in the Pn0 group showed an improved disease-free and long-term survival compared to the Pn1 group (p < 0.001). Subgroup analysis of all R0-resected patients indicated improved long-term survival and disease-free survival of R0 Pn0 patients when compared to R0 Pn1 patients (p < 0.001). (4) Conclusion: Our study confirmed that Pn0 improves the long-term survival of PDAC-resected cancer patients. Furthermore, PNI significantly challenges the long-term survival of formally curative (R0) resected patients. We provide new insights into the dynamics of PNI in pancreatic cancer patients which are needed to define subgroups of patients for risk stratification and multimodal treatment strategies.
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